FORM VAT-36

[See proviso to rule 54(1)]

REFUND ADJUSTMENT ORDER

(In duplicate)

1. Certified with reference to the assessment records of the dealer (name) __________________________________ bearing TIN _____________________ /Registration No.______________/TOT/CT that a refund of (in figure) Rs.__________________________ is due.

2. Certified that the tax concerning which this refund is allowed has been credited into the treasury.

3. Certified that no refund order regarding the sum is question has previously been granted and this order of refund has been entered in the original file of assessment under my signature

4. This refund will be adjusted towards the amount of sales tax due from the said dealer for the quarter ____________________.

5. The dealer shall attach this order to the return to be furnished by him for the quarter against which the adjustment is desired.

Signature of the

Issuing Authority

Place:

Date: